Nerve-Sparing Hood Cystectomy with Totally Intracorporeal Neobladder
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Background: Prior studies on robotic prostatectomy have shown that preserving the anterior periprostatic structures is associated with good functional outcomes in terms of urinary continence (UC) and erectile function (EF). With this in mind we developed a technique for preserving the lower part of the detrusor apron and anterior periprostatic structures (hood of periprostatic tissue) at the time of robot-assisted radical cystectomy (RARC) and intracorporeal neobladder reconstruction. Herein, we aimed to describe our hood-sparing RARC and to assess its outcomes.
Methods: We retrospectively evaluated 11 patients who underwent hood-sparing RARC at our centre from January 2020 to January 2021. Primary outcomes were UC and EF at 12-month. Concerning the surgical technique, after having developed the plane posterior to bladder and prostate, the dissection moves laterally on both sides in an effort to identify the bladder and prostate pedicles. The endopelvic fascia is preserved. The pedicles are sectioned in an antegrade fashion. The neurovascular bundles, the and the lateral and anterior periprostatic structures are preserved in toto.
Results: Median console time was 210 min. At 12-month all patients reported daily continence or use of a safety pad; at night, 7 patients were continent or used a safety pad. Regarding 12-month EF, 4 patients were potent without the need of medication, 6 with the use of oral PD5i and one through intracavernosal injections.
Conclusions: Our data on hood-sparing RARC suggest that this approach is associated with good functional outcomes in terms of urinary continence and erectile function. A prospective study will follow.